Provider Demographics
NPI:1649365859
Name:ADA I VERA DPM LTD
Entity type:Organization
Organization Name:ADA I VERA DPM LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-878-5252
Mailing Address - Street 1:PO BOX 33250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3250
Mailing Address - Country:US
Mailing Address - Phone:702-878-5252
Mailing Address - Fax:702-878-1963
Practice Address - Street 1:3000 W CHARLESTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1940
Practice Address - Country:US
Practice Address - Phone:702-878-5252
Practice Address - Fax:702-878-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0016213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty